Bleeding Problems

Approved by the Cancer.Net Editorial Board, 09/2019

When a person has a bleeding disorder, his or her blood does not clot fast enough. This results in too much bleeding or bleeding that lasts a long time.

Normal blood clotting is called coagulation. This complex process involves platelets and clotting or coagulation factors. Platelets are special blood cells. And clotting or coagulation factors are types of proteins found in the blood.

Platelets and coagulation factors clump together to heal broken blood vessels. This helps control bleeding. A person needs the right balance of coagulation factors to have healthy bleeding and clotting.

Blood clotting disorders occur when:

  • Clotting factors are missing or damaged.

  • The blood has too few platelets.

  • Platelets do not work correctly.

Symptoms of bleeding problems

People with bleeding disorders may have the following symptoms:

  • Cuts that bleed too much

  • Unexpected or sudden bruising

  • Small purple or red spots under the skin called petechiae

  • Blood in vomit that often looks like coffee grounds.

  • Black or bloody bowel movements

  • Red or pink urine

  • Dizziness, headaches, or changes in vision

  • Joint pain

  • Gum or nose bleeding

  • Menstrual periods in women that are heavier or longer than usual

Talk with your health care team about any symptoms you have. In particular, tell them about new symptoms or a change in symptoms.

Causes of bleeding problems

Sometimes a person inherits a bleeding disorder. This means it is genetic and runs in the family. A person may also have bleeding problems caused from illness or treatment with specific drugs.

Bleeding problems can be caused by:

  • Inherited disorders. Hemophilia and von Willebrand’s disease are 2 types. With hemophilia, blood does not clot normally. With von Willebrand's disease, clotting factors are missing or do not work well.

  • A vitamin K deficiency

  • Cancer that begins in or spreads to the liver

  • Other liver disorders, including hepatitis and cirrhosis. Hepatitis is an infection of the liver. Cirrhosis is scarring of the liver.

  • Long-term use of powerful antibiotics or anticoagulants. Anticoagulants are medications that thin the blood.

  • Drugs called angiogenesis inhibitors. These prevent the growth and development of new blood vessels.

  • Thrombocytopenia, which is an unusually low level of platelets

  • Anemia, which is an unusually low level of red blood cells

  • Other disorders unrelated to cancer

Diagnosing bleeding problems

Your health care team will review your medical history, perform a physical exam, and draw blood. The blood may be used for several blood tests including:

Treating bleeding problems

Relieving side effects is an important part of cancer care and treatment. This is called palliative care or supportive care. It helps meet the physical, emotional, and social needs of the person with cancer.

When possible, the health care team treats a bleeding disorder’s underlying cause, such as cancer or liver disease. Additional treatments may include:

  • A vitamin K injection

  • Drugs that help blood to clot

  • Blood plasma or platelet transfusions

  • Other medications to treat platelet problems. These include hydroxyurea (Droxia, Hydrea) and oprelvekin (Neumega).

Related Resources

ASCO Answers Fact Sheet: Understanding Blood Tests (PDF)

When to Call the Doctor During Cancer Treatment

ASCO answers; Understanding Complete Blood Count (CBC) TestsDownload ASCO's free 1-page (front and back) fact sheet on Understanding Complete Blood Count (CBC) Tests as a printable PDF. This introduction to understanding blood test results has information on complete blood count, white blood cell count, white blood cell differential, red blood cell count, and platelet count, as well as words to know, and questions to ask the healthcare team.